Individual
MR. RICKY A PERSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC. ICS
Contact information
Practice address
4810 NORTHWESTERN AVE, MOUNT PLEASANT, WI 53406
(262) 583-2714
Mailing address
4810 NORTHWESTERN AVE # 100, MOUNT PLEASANT, WI 53406-1504
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11919-134
WI
Other
Enumeration date
12/02/2013
Last updated
07/10/2018
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